Addiction Severity Index

1. Addiction Severity Index (Training) 1 10/15/2003 Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

2. Goals To develop and/or enhance the interviewers competency. To correctly utilize the ASI tool. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

3. Keys to Success • Learn to be flexible • Learn to be comfortable with the process • Learn to probe Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

4. Screening and Assessment • Screening tools establish the presence or absence of a problem. • Screening tools are not diagnostic tools. • ASI is a multi focused screening tool. • Single focused assessment tools are: • DAST: Strictly drug issues • MAST: Strictly mental health issues Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

5. Screening and Assessment cont. • Assessment initiates and guides the continuum of care. • Assessment must occur throughout the treatment process. • Assessment must be done with patient involvement. • Ongoing assessment is necessary as an on-going evaluation of treatment. • May indicate the need for more comprehensive tools. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

6. ASI • Standard semi-structured multi-focused screening and assessment tool. • Designed for use primarily with substance abuse patients. • Used to collect information regarding the nature and severity of problems substance abusers often have. • Used for clinical program evaluation and research applicability. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

7. Clinical Applications • Guides substance abuse treatment intake. • Designs intake summaries. • Develops treatment plans. • Makes referral suggestions. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

8. Program Evaluation • Identifies types of patients and problems presenting for treatment. • Identifies the clinic staff strengths and areas for improvement with particular populations and problems. • Enables management by outcome. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

9. Benefit of Using the ASI • Reliable assessment instrument. • Assist in identifying dully diagnosed patients. • Can be re-administered at different points in treatment. • Helps identify inconsistencies in patient responses. • Widely used can compare your program results with others. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

10. Strengths of Using the ASI • One hour administration. • Comprehensive in scope. • Widely accepted by national organizations. • Flexible • Can accommodate different counseling and interviewing styles. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

11. Limitations • Does not provide quantity estimates of alcohol and drug use (it identifies patterns). • Does not directly assess risk of HIV. • Does not cover issues that are specific to treating female patients. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

12. Common Concerns • Seems too complicated. • Does not include all areas the program currently assesses. • Seems too rigid. • Seems like more work. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

13. Common Questions • Is it filled out by the interviewer or self administered? • What are the qualifications of an ASI interviewer? • Is frequency instead of quantity of use assessed? • Why is there a thirty day reporting period? • Can interviewers re-ask or omit questions? • Can the ASI be modified? Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

14. Coding and Rating the ASI • Evaluate non-drug and alcohol problems independently. • Critical objective items (depending on how the patient answers, this is the basis of our rating). • Circled items are asked at follow-up sessions 30 days, 90 days or 1 year. • Asterisked (*) counselors will need rephrase these questions at follow-up sessions. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

15. Introducing the ASI • All patients receive the same standard interview. • The interview will take approximately 50-60 minutes. • All information gathered is confidential. • Patients may choose to not answer certain questions. • Encourage honesty versus misinformation. • Accurate information better equips us to help the patient. • There are two time frames we will discuss: • The past 30 days • Lifetime Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

16. Seven Potential Problem Areas • Medical • Employment • Alcohol • Drug • Legal • Family/Social • Psychiatric Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

17. General Information Section • To provide identifying demographic information about the patient. • To determine if he or she has been in a living situation which restricted freedom of movement and access to alcohol and other drugs. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

18. Medical Information Section • To gather information about • Patient’s medical history • Lifetime hospitalization • Long term medical problems that require medical observation or medical attention • Recent physical ailments Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

19. Employment Section • To gather basic information about: • Resources patients can record on a job application • Current sources of income Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

20. Drug and Alcohol Section • To gather information about patient’s substance abuse history • Lifetime substance abuse • Consequences of abuse • Periods of abstinence • Treatment episodes • Financial burden of abuse Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

21. Alcohol and Drug Section Coding Conventions • Regular use defined as 3 times a week or more. • Problematic irregular use in which normal activities are compromised (binges). • Alcohol to intoxication. This does not necessarily mean drunk. • Intoxication is to feel or felt the effects. • Heavy drinking is 3 drinks in a sitting or 5 drinks in a day. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

22. Legal Status Section • To gather basic information about: • Patient’s legal history • Information about probation or parole. • Charges, convictions, incarcerations, detainment and illegal activities. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

23. Family History Section • Summarizes the psychiatric, alcohol and drug abuse problems of the patient’s biological relatives. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

24. Family and Social History Section • To determine the nature of the patient’s personal relationships. • To determine if he or she has relationship problems not due to alcohol or other drug use. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

25. Psychiatric Status Section • To determine the patients long term and recent psychological and emotional functioning. • To explore the potential for dual diagnosis. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

26. Coding and Rating • Leave no blanks – only one character/number per box. • Questions not answered: X • Questions that do not apply: N • Time periods: Lifetime and last 30 days. • Two distinct and different time frames. • Evaluate non-drug/alcohol problems independently (do not relate all issues to drugs and alcohol). Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

27. Coding and Rating cont. • Critical objective items (could be the basis of how we rate). • Circle items ask at follow-up. • Asterisked (*) items: cumulative questions, adjust time frames/rephrase at follow-up. • Make plenty of comments, when noting write the question number. • Terminate interview if clients misrepresents two of more sections. Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.

28. 0 – None, not at all 1 – Slightly 2 – Moderately 3 – Considerably 4 - Extremely 0-1 No real problem, treatment not indicated. 2-3 Slight problem, treatment probably not indicated. 4-5 Moderate problem, some treatment indicated. 6-7 Considerable problem, treatment necessary. 8-9 Extreme problem, treatment absolutely necessary. Coding and Rating Patient Rating Scale: Interviewer Range: Copyright 2003 Aegis Medical Systems, Inc. All rights reserved.